World Heart Day: Pediatric Cardiologist Dr. Jasleen Kaur on Congenital Heart Defects and Advances in Care

Dr. Jasleen Kaur: As a pediatric cardiologist, I'm basically involved in diagnosing heart disease in children and managing them.

Management involves both medical management and subsequent interventions if needed, like device closure of heart defects, opening of stenosed valves, etc.

Dr. Jasleen Kaur: Congenital heart defects are basically structural heart defects with which a baby is born. Many are detected at birth due to their symptoms, while many are diagnosed later on by either some symptoms or an additional or abnormal heart sound during examination.

Heart defects in children are very common, and nearly 8–10 out of every 1,000 children have a heart defect.

Dr. Jasleen Kaur: Pediatric heart defects are diagnosed either by symptoms which the mother reports, like feeding issues or poor weight gain, or by signs like bluish discoloration of lips and nails, or an additional sound heard in the chest during routine check-up or vaccination.

They are confirmed by chest X-ray and echocardiogram.

Dr. Jasleen Kaur: Yes, most congenital heart defects can be diagnosed before birth by fetal echo (a specialized ultrasound), which is done at 18–22 weeks of gestation. Nowadays, due to high-end technology, most defects can be diagnosed before birth.

No, I haven't performed fetal interventions. There are very few centers in India that perform interventions in the fetus before the child is born.

Dr. Jasleen Kaur: Signs that might suggest heart defects are feeding issues in infants, stoppage of feeds in between, sweating while feeding, breathing difficulties, poor weight gain, palpitations felt by children, recurrent chest infections, and episodes of bluish discoloration of lips and nails noted by parents.

Isolated chest pain is rarely associated with heart defects in children, unlike adults.

Dr. Jasleen Kaur: Heart defects in children can be managed both conservatively and by interventions depending on the type of heart defects.

Hole in heart which is a common term used by parents mostly can be managed non- surgically by interventions in which devices can be deployed through angiographic procedures.

For more complex disease, surgery is required. Nonetheless, monitoring is required for all heart defects.

Dr. Jasleen Kaur: Follow-up care is very important for children with heart defects. Both pre- and post-surgical follow-ups are required, which are done through clinical examination, ECG, and echocardiogram.

Dr. Jasleen Kaur: Not all heart defects need restrictions for a child's activities. In fact, most of them don't need any restriction. Complex heart disease may require restrictions before surgery, but after surgery, most of them are advised to do normal activities.

Children should never be deprived of going to school because of heart defects, as most of them can be managed by medications or interventions whenever needed.

Dr. Jasleen Kaur: Yes, some risk factors in pregnancy can be avoided, like certain drugs or toxin exposure. Medicines should be taken only after consultation. Mothers who develop fever or medical conditions like gestational diabetes are also more likely to have babies with heart defects, but not all heart defects have a cause. Many genetic conditions are undetected and may lead to heart defects in babies. So, mostly heart defects are not preventable, as most causes are not known. The only precaution is undergoing proper scans during pregnancy as advised, including a fetal echo scan.

Dr. Jasleen Kaur: Nowadays, newer technologies, both in diagnosis and interventions, have given better care for heart defects in children.

Fetal echo with upgraded technology can diagnose almost 99% of heart defects. Also, fetal interventions are available in some centers where prenatal procedures can be done. Nowadays, interventions in children are done for most heart defects so that they don't have to undergo surgery. Also, surgical techniques have advanced. So, in a nutshell, almost all heart defects in children are correctable, and in some cases, palliative care can be given. Life span and quality of life have also improved in these children.

Dr. Jasleen Kaur: There are many myths that families of children with heart defects often believe. One common misconception is that heart defects are caused by some defect in the mother. It is important to clarify that the formation of the heart is a complex process during pregnancy, and even a single gene defect can result in various complex issues related to heart development. Therefore, heart defects are not solely related to maternal factors; they can occur in any pregnancy.

Another misconception is that people often struggle to accept that heart defects can occur in newborns or young children. Heart defects are congenital, meaning they occur before birth. While some defects can be detected at birth, others may not be identified until later.

Additionally, many parents believe that if their child has a heart defect, it is not correctable. However, nowadays, nearly all heart defects can be treated. If diagnosed, it is crucial for families to seek necessary interventions or surgeries for their children.

Cost is also a concern for many families, but there is increasing awareness and support from various organizations and NGOs. These groups often help reduce the costs associated with procedures, making them more affordable for families.

In conclusion, I believe that it is essential to suspect heart defects and confirm them through an echocardiogram. Children with heart defects should receive corrective measures so that every child has the opportunity to live a life similar to that of any other healthy child.